1. Field of the Invention
The present invention relates to the field of surgery and, in particular, to a Lisfranc repair technique using a suture-button or suture anchor-button construct.
2. Description of the Related Art
Lisfranc injury is an injury to one of the small joints of the midfoot. The injury occurs when there is a dislocation or fracture and dislocation between the forefoot and midfoot joints.
Referring to FIG. 1, the foot has three main parts: the forefoot, the midfoot, and the hindfoot. The forefoot is composed of the five toes, called phalanges 1, 2, 3, and their connecting long bones, called metatarsals 4. Each toe, except the big toe, is made up of three phalanges—proximal phalange 1, middle phalange 2, and distal phalange 3—and two joints. The phalanges 1, 2, 3 are connected to the metatarsals 4 by the metatarsal phalangeal joints at the ball of the foot. The big toe has two phalanges—distal phalange 3, and proximal phalange 1—and a joint called the interphalangeal joint. The big toe articulates with the head of the first metatarsal 4a and is called the first metatarsophalangeal joint (MTPJ). Underneath the first metatarsal 4a head are two tiny, round bones called sesamoids.
The midfoot has five irregularly shaped tarsal bones—navicular 5, medial cuneiform 6a, intermediate cuneiform 6b, lateral cuneiform 6c, and cuboid 7. The bones of the midfoot are connected to the forefoot and the hindfoot by muscles and the plantar fascia called arch ligament.
The hindfoot is composed of the talus 8 (lower ankle) and calcaneus 9 (heel). The top of the talus 8 is connected to the tibia and fibula of the lower leg forming a hinge that allows the foot to move up and down. The calcaneus 9 joins the talus 8 to form the subtalar joint.
Tarsometatarsal articulations are arthrodial joints in the foot, also known as the “Lisfranc joint.” The Lisfranc joint is the medial articulation involving the first 4a and second metatarsals 4b with the medial 6a and intermediate 6b cuneiforms. The Lisfranc ligament is a large band of plantar collagenous tissue that spans the articulation of the medial cuneiform 6a and the base of the second metatarsal 4b. A Lisfranc injury is an injury to the Lisfranc ligament which can occur as a result of direct or indirect trauma. Sometimes, the Lisfranc injury is a dislocation such as a ligament injury or a fracture and dislocation. The dislocation may be a separation of the joints between the forefoot and the midfoot. The fracture usually occurs in the midfoot bones.
The treatment of a Lisfranc injury is often surgical, though some minor injuries can be treated conservatively. In the case of a minimal displacement of the bones, a stiff walking cast applied for approximately eight weeks may suffice. However, the more common treatment is to secure the fractured and dislocated bones with internal or external fixation means.
Thus, there is a need for a Lisfranc repair technique that is simple, flexible and is performed by a minimally invasive lateral approach, with placement of buttons across the lateral margin of the medial cuneiform and the medial second metatarsal.